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At least 253 records · Page 14Linked to original sources
PubMed2000

Computer-assisted fluoroscopy-based reduction of femoral fractures and antetorsion correction.

OBJECTIVE: Intra-operative fluoroscopy is a valuable tool for visualizing underlying bone, implant, and surgical tool positions in orthopedics. It has brought about the minimally invasive surgical technique of intramedullar nailing to fix femoral shaft fractures. However, the limited field of view and two-dimensional property of fluoroscopic images aggravate intra-operative control of surgical parameters. The purpose of this article is to introduce a surgical navigation system based on fluoroscopy that provides missing information for the procedure of femoral fracture fixation. MATERIALS AND METHODS: Optoelectronic markers are placed on a surgical drill, involved bone fragments, the femoral nail, and the fluoroscope to track their positions. Projection properties of the fluoroscope are acquired through an initial precalibration. The relative positions of bone fragments, implants, and surgical tools are displayed superimposed simultaneously and in real time on multi-planar intra-operative fluoroscopic images. This is achieved by computer simulation of X-ray projections that have taken place with acquisition of the fluoroscopic images. In addition, a method has been developed that allows contactless measurement of three-dimensional anatomic landmarks, based on their representation in fluoroscopic images. In combination with optoelectronic tracking, this enables dynamic calculation of important surgical parameters such as femoral antetorsion. RESULTS: A pilot surgery showed that fracture reduction can benefit from the developed computer-assisted method. An in-vitro study on computer-assisted measurement of femoral antetorsion demonstrated the high degree of precision of this technique.

Bone Nails↗
PubMed2001

Passive tracking of catheters and guidewires by contrast-enhanced MR fluoroscopy.

Passive MR tracking of catheters and guidewires is usually done by dynamically imaging a single thick slab, subtracting a baseline image, and combining the result with a previously acquired MR angiogram. In the in vitro and in vivo experiments reported here, it is demonstrated that this approach may be greatly simplified by using a suitable intravascular contrast agent. The proposed method, contrast-enhanced MR fluoroscopy, combines tracking and angiography into a single sequence and allows direct visualization of the magnetically prepared parts of catheters and guidewires with respect to the vasculature at a frame rate of about one image per 1.5 seconds. Contrast-enhanced MR fluoroscopy, although still limited in temporal resolution, thus obviates the need for subtraction and overlay techniques and eliminates the sensitivity of tracking to subject motion between acquisitions. Magn Reson Med 45:17-23, 2001.

Animals↗
PubMed1992

Mitral balloon valvuloplasty with transesophageal echocardiography without using fluoroscopy.

Balloon mitral valvuloplasty with Inoue technique was performed in two group of patients. In group I (n = 40) valvuloplasty was performed under fluoroscopy without using echocardiography, whereas in group II (n = 13) valvuloplasty was performed under the guidance of transesophageal echocardiography alone, without using fluoroscopy. Patients in two groups were comparable with regard to clinical variables and hemodynamic parameters. Two female patients in group II were pregnant. Transmitral pressure gradient decrease did not differ significantly between two groups (pressure gradient: 17 +/- 5 to 4 +/- 1 in group I and 15 +/- 4 to 3 +/- 1 mm Hg in group II). Mitral valvular area increase was also not different in two groups (1.09 +/- 0.2 cm2 to 2.3 +/- 0.5 cm2 in group I and 0.9 +/- 0.2 to 2 +/- 0.3 cm2 in group II). In 14 cases from group 1 and 2 cases from group II mitral regurgitation increased after valvuloplasty (p < .05). Left atrial perforation occurred in one patient from group 1 and 2 patients from group II. In conclusion, mitral balloon valvuloplasty under transesophageal echocardiographic guidance alone is a safe and effective procedure in the treatment of mitral stenosis.

Adult↗
PubMed1987

Increased chromosome damage in pediatric heart catheterization patients after diagnostic fluoroscopy and cineangiography.

Chromosome damage (CD) and sister chromatid exchange (SCE) levels were studied in lymphocytes from 30 pediatric heart catheterization patients receiving radiation during diagnostic fluoroscopy and cineangiography procedures. Forty-eight-hour CD and 72-hr SCE cultures were prepared from sequential samples taken from each patient: samples 1-3 via the catheter the same day (1) before exposure, (2) after fluoroscopy, and (3) after cineangiography; and sample 4 by venipuncture the next morning. Significant increases in CD (dicentrics, rings, and fragments), but not SCE, were observed. From a mean base level of 0.4% cells with CD, the CD levels increased 2-3-fold in samples 3 and 4 (p = .001). Rings only occurred in samples 3 and 4. While increased CD levels also correlated with increasing age, body surface area, and weight, partial correlations controlling for these factors clearly indicate that the CD effects are principally attributable to the radiological procedures (p = .001). Increased CD levels correlated with both the roentgen dose of cineangiography exposure (p = .002) and the volume of contrast medium (p = .000); however, partial correlations, controlling for either factor, indicate that the contrast medium was the principal factor (p = .006).

Cardiac Catheterization↗
PubMed1996

Cardiac magnetic resonance fluoroscopy.

A technique is described for high speed interactive imaging of the heart with either white or black blood contrast. Thirty-two views of a segmented, magnetization-prepared gradient echo sequence are acquired during diastole. Using three-quarter partial Fourier sampling, data for a complete 128 x 128 image are acquired in three cardiac cycles. High speed reconstruction provides an image update of each cardiac cycle 159 ms after measurement. An independent graphical user interface facilitates interactive control of section localization and contrast by permitting pulse sequence parameter modification during scanning. The efficiency and image quality of the cardiac MR fluoroscopy technique were evaluated in 11 subjects. Compared with the conventional graphic prescription method, the cardiac fluoroscopy technique provides an approximate eightfold reduction in the time required to obtain subject-specific double oblique sections. Image quality for these scout acquisitions performed during free breathing was sufficient to identify small cardiac structures.

Coronary Angiography↗
PubMed2006

3D fluoroscopy with real-time 3D non-cartesian phased-array contrast-enhanced MRA.

For optimized CE-MRA of the chest and abdomen, the scan time and breath-hold must be coordinated with the arrival of contrast. A 3D fluoroscopy system is demonstrated that performs real-time 3D projection reconstruction acquisition, reconstruction, and visualization using only the standard scanner hardware and operator console workstation. Unlike 2D fluorotriggering techniques, no specification of a monitoring slab or careful placement of the imaging volume is required. 3DPR data are acquired continuously throughout the examination using an eight-channel receiver and 1 s interleaved subframes. The data are reconstructed using 1 s segments for real-time monitoring with 0.8-cm isotropic spatial resolution over the entire torso, allowing full-volume axial, coronal, and sagittal MIPs to be displayed simultaneously with minimal latency. The system later uses the same scan data to generate high-spatial-resolution time-resolved sequences of the breath-hold interval. The 3D fluoroscopy system was validated on phantoms and human volunteers.

Artifacts↗
PubMed1997

[A comparison of a fluoroscopy-free mechanical targeting system and a free-hand technic for the placement of distal interlocking screws of tibial nails].

Recently, radiation-independent aiming devices for the tibia which compensate for insertion-related implant deformation have been developed, but the benefits of such systems have not been determined. This study prospectively evaluated the duration of the nailing procedure, the length of radiation time, and the accuracy of interlocking screw placement with a radiation-independent distal aiming system and the free-hand technique. In an oblique cadaveric tibial fracture, a surgeon inexperienced with either technique performed a statically locked intramedullary nailing. For the aiming system and free-hand technique respectively, the total operation time was 25.4 +/- 11.3 vs 30.9 +/- 14.3 min (P = 0.029), the distal locking time was 16.7 +/- 8.6 vs 21.9 +/- 10.5 min (P = 0.004), the total fluoroscopy time was 9 +/- 5 vs 93 +/- 34 s (P < 0.0001), the distal locking fluoroscopy time was 0 versus 88 +/- 33 s (P < 0.0001), and the screw destruction was -0.7 +/- 5.2 vs 26.8 +/- 31.6 microns (P = 0.001). The failure rate was 1.6% (1 of 60 screws) in both groups. These results suggest that aiming devices can eliminate the need for radiation during distal interlocking screw placement.

Adult↗
PubMed2003

[CT and fluoroscopy based navigation in pelvic surgery].

Navigation procedures based upon CT data were introduced into spine surgery in 1994. Since then the method has been used in other areas, such as joint replacement, reconstructive surgery and tumor surgery, because of its high precision and reduced radiation exposure. The original CT-based spine module can be adapted for pelvic surgery with the prerequisite, that the positioning of the fragments is identical in CT and at operation; otherwise, a new data set has to be acquired. The experience with CT-based navigation in pelvic surgery will be explained in the context of five percutaneous screw fixations and three tumor resections. The technique will be described. The fluoroscopy-based navigation has been used in trauma surgery since the late 1990 s. Since than the method has gained wide acceptance in the field of joint replacement and reconstructive surgery as well. Between June 2000 and December 2002 we performed 36 percutaneous screw fixations in the pelvis with postoperative X-ray and CT control. Thirty five of the 36 screws were placed correctly. In one screw an anterior cortex perforation of the sacrum was seen on CT, but without neurological consequences. Based upon our clinical experience we believe that CT-based navigation is indicated in screw fixations for minimally displaced pelvic injuries or dysplasia and, with increasing importance, in tumor surgery. Fluoroscopy based navigation with adequate image quality is the method of choice for SI screw fixations in traumatic or degenerative instabilities, especially if an update of the images is needed.

Bone Neoplasms↗
PubMed2000

Prediction of breaking strength in osteoporotic avian bone using digitized fluoroscopy, a low cost radiographic technique.

Bone fragility in caged laying hens is a severe welfare problem, with fracture incidences in commercial flocks of up to 30% of all hens during their life. This fragility has been attributed to osteoporosis, the etiology of which is multifactorial in birds, as in humans, with genetic, environmental, and nutritional components. Greater understanding of the development of the disorder in hens could be obtained from the same kind of in vivo assessments available in human studies of osteoporosis. These high technology techniques for evaluation of bone mineral density (BMD), such as single or dual energy X-ray absorptiometry (SXA or DXA), quantitative computerized tomography (QCT), or attenuation by ultrasound (US), are so far not widely available to nonclinical researchers. We have modified an older X-ray film technique, radiographic absorptiometry (RA) by digitization of the analog video signal from a Philips BV-25 image intensifier, in single pulse fluoroscopy mode, and subsequent computer analysis with the public domain software package, NIH-Image 1.60. Compared with conventional RA, which uses standard X-ray film, our modified technique reduces X-ray exposure and allows the operator to digitize, store, and analyze many more images in a shorter time. We have called this modified technique "digitized fluoroscopy" (DF). In a longitudinal study of humeral radiographic density in a flock of 165 laying hens, significant relationships (P < 0.001) were observed between assessments made as early as 25 weeks, utilizing this DF technique in the humerus, and breaking strengths (and other postmortem indicators of osteoporosis) measured at 70 weeks. We conclude that DF can predict some eventual parameters of bone mass measured at 70 weeks from 25 to 40 weeks onward in bones from the same site in laying hens. The relationship between DF measurements made in the humerus and postmortem measurements of radiographic density and breaking strength made at another site (tibia) are less strong but still significant from 40 weeks onward.

Absorptiometry, Photon↗
PubMed2002

Pressure-assisted micturating cystourethrography: reduction in duration of procedure and fluoroscopy time.

BACKGROUND: Micturating cystourethrography (MCU) can be a prolonged and uncomfortable examination when contrast medium is instilled by gravity through a narrow-bore catheter. Some radiologists increase the filling rate by injecting contrast medium using syringes, but this is cumbersome. In our hospital, one radiologist routinely injects air into the bottle of contrast medium to speed flow. OBJECTIVE: To assess whether pressure-assisted flow of contrast medium shortens examination times compared with gravity feed. MATERIALS AND METHODS: A prospective study of MCU in 142 children aged 0.04-13.3 years, of which 41 procedures were assisted by air injected into the bottle of contrast medium to maintain a steady stream of contrast medium and 101 were gravity fed. The time from starting contrast medium infusion to the end of the procedure, fluoroscopy time and dose-area product were recorded. A 6-Fr catheter was used in all examinations. RESULTS: The mean duration of the examination was reduced from 9.1 to 3.4 min ( P<0.0001), the mean fluoroscopy time was reduced from 1.5 to 1.0 min ( P<0.0002) and the mean dose-area product was reduced from 27.4 to 17 cGy.cm(2).

Adolescent↗
PubMed2006

Management of pediatric radiation dose using Philips fluoroscopy systems DoseWise: perfect image, perfect sense.

Although image quality (IQ) is the ultimate goal for accurate diagnosis and treatment, minimizing radiation dose is equally important. This is especially true when pediatric patients are examined, because their sensitivity to radiation-induced cancer is two to three times greater than that of adults. DoseWise is an ALARA-based philosophy within Philips Medical Systems that is active at every level of product design. It encompasses a set of techniques, programs and practices that ensures optimal IQ while protecting people in the X-ray environments. DoseWise methods include management of the X-ray beam, less radiation-on time and more dose information for the operator. Smart beam management provides automatic customization of the X-ray beam spectrum, shape, and pulse frequency. The Philips-patented grid-controlled fluoroscopy (GCF) provides grid switching of the X-ray beam in the X-ray tube instead of the traditional generator switching method. In the examination of pediatric patients, DoseWise technology has been scientifically documented to reduce radiation dose to <10% of the dose of traditional continuous fluoroscopy systems. The result is improved IQ at a significantly lower effective dose, which contributes to the safety of patients and staff.

Body Burden↗
PubMed2000

Diagnosis of the cause of malfunction of indwelling catheters for insulin injections by the use of digital fluoroscopy.

BACKGROUND: Subcutaneous indwelling catheters are used for reducing pain when injecting insulin and other drugs. OBJECTIVE: To use digital fluoroscopy for the diagnosis of catheter malfunction. MATERIAL AND METHODS: Seven children (aged 5-11 years) with diabetes mellitus were studied. They used indwelling catheters (Insuflon) for insulin injections. Contrast medium was injected into the problem catheter. RESULTS: The subcutaneous position of the catheter was correct in all cases, but we found two cases of delayed absorption caused by lipohypertrophy and one case of leakage. CONCLUSIONS: Digital fluoroscopy is a useful method for determining potential problems with indwelling catheters.

Age Factors↗
PubMed2001

Paediatric pelvic imaging: optimisation of dose and technique using digital grid-controlled pulsed fluoroscopy.

BACKGROUND: An audit of paediatric pelvic radiographs identified deficiencies in gonad shield placement and radiographic technique. OBJECTIVE: A technique using grid-controlled fluoroscopy (GCF), with hard copy images in frame grab and digital spot image (DSI) format was evaluated to optimise gonad shield placement and reduce the dose given to children with Perthes disease and Developmental Hip Dysplasia (DDH) attending for pelvic radiography. MATERIALS AND METHODS: Phantom and patient dose surveys of conventional and fluoroscopic techniques were carried out. Image quality and radiation dose were compared for the frame grab and DSI techniques. Retrospective evaluation was undertaken to compare their clinical acceptability. RESULTS: Both fluoroscopic techniques gave considerably less radiation than conventional non-grid radiography (67-83%, P < 0.05). The frame grab technique gave less radiation than DSI (P < 0.05). There was no significant difference in the clinical acceptability scores of the DSI and frame grab images. CONCLUSION: Fluoroscopy acquired images are now used since the fluoroscopic techniques give much less dose than conventional radiography and provide images of sufficient quality for clinical assessment. Indeed, as there was no significant difference in clinical usefulness between the frame grab and DSI techniques, it is planned to use frame grab alone, thus gaining additional dose saving.

Adolescent↗
PubMedDate not supplied

CT fluoroscopy-guided catheterization of the celiac and mesenteric arteries for concurrent CTHA and CTAP.

We describe a technique for computed tomographic (CT) fluoroscopy-guided celiac artery or superior mesenteric artery (SMA) catheterization for use with CT hepatic arteriography or CT arterial portography, respectively. Patients underwent conventional hepatic angiography to define the anatomy and to place a catheter within the celiac artery or the SMA. Subsequently, the catheter was repositioned in the target vessels under CT fluoroscopy. Our success rate was 94%.

Catheterization, Peripheral↗
PubMedDate not supplied

CT-fluoroscopy: Tool or gimmick?

Recent advances in CT scanner technology and computer hardware have led to the development of CT fluoroscopy (CTF), which allows real-time acquisition and display of cross-sectional images (with a rate of up to 8 frames per second). Since the introduction of the first CT fluoroscopy scanner in 1993, a variety of these scanners have been installed world-wide and many reports on the clinical use of this device have appeared recently. However, use of this new technology for the guidance of interventional radiologic procedures, such as percutaneous biopsy and percutaneous drainage, is not uniformly advocated by interventional radiologists. Concerns have been reported regarding radiation exposure and outcome of the procedures when compared with sequential CT guidance or other alternative guiding modalities. This article is intended to present an overview of CTF technology, to summarize the results of published papers on various interventional applications and to reflect on its specific advantages and disadvantages.

Biopsy↗
PubMed2006

How to set up and apply reference levels in fluoroscopy at a national level.

A nationwide survey was launched to investigate the use of fluoroscopy and establish national reference levels (RL) for dose-intensive procedures. The 2-year investigation covered five radiology and nine cardiology departments in public hospitals and private clinics, and focused on 12 examination types: 6 diagnostic and 6 interventional. A total of 1,000 examinations was registered. Information including the fluoroscopy time (T), the number of frames (N) and the dose-area product (DAP) was provided. The data set was used to establish the distributions of T, N and the DAP and the associated RL values. The examinations were pooled to improve the statistics. A wide variation in dose and image quality in fixed geometry was observed. As an example, the skin dose rate for abdominal examinations varied in the range of 10 to 45 mGy/min for comparable image quality. A wide variability was found for several types of examinations, mainly complex ones. DAP RLs of 210, 125, 80, 240, 440 and 110 Gy cm2 were established for lower limb and iliac angiography, cerebral angiography, coronary angiography, biliary drainage and stenting, cerebral embolization and PTCA, respectively. The RL values established are compared to the data published in the literature.

Diagnostic Imaging↗
PubMed1998

Detection of coronary artery calcifications predicting coronary heart disease: comparison of fluoroscopy and spiral CT.

The aim of this study was to evaluate the clinical relevance of coronary artery calcifications detected by spiral CT, congruence with fluoroscopy (FS) and coronary angiography, and comparison with studies reporting on application of double-helical CT and ultrafast CT. Forty patients underwent spiral CT (2-mm slice thickness, table feed 3 mm/s), coronary angiography, and FS (performed in the usual manner). Stenosis and calcifications were evaluated semiquantitatively. Nineteen patients suffering from a stenosis >/= 75 % were verified at coronary angiography. All had coronary artery calcification on spiral CT. Fluoroscopy did not detect 8 of 19 patients with a stenosis >/= 75 % (1 vessel: n = 1; 2 vessels: n = 3; 3 vessels: n = 4). In spiral CT sensitivity was 100 % and specificity was 33 % (FS: 58 and 48 %). Positive predictive value was 83 % for spiral CT (FS: 50 %), and negative predictive value was 100 % (FS: 56 %). A significant linear increase in the calcification score was found for increasing maximal stenosis (p < 0.005). Spiral CT is more sensitive than FS in the recognition of hemodynamic relevant stenoses using the detection of coronary artery calcifications. Statistical parameters are comparable to ultrafast-CT. Spiral CT is a suitable non-invasive diagnostic technique in coronary heart disease. Coronary calcifications found incidentally in symptomatic patients at chest CT should be reported to the referring physician for further cardiological workup.

Adult↗
PubMed2005

Placement of pacemaker leads via the extrathoracic subclavian vein guided by fluoroscopy and venography in the oblique projection.

Blind needle puncture of the subclavian vein, which is the standard method used for insertion of pacemaker electrodes, causes an increased risk of lead fractures due to entrapment of the lead by the costoclavicular ligament and/or subclavius muscle. The extrathoracic lead insertion technique was developed to prevent such lead fractures. The present study was performed to evaluate the usefulness of extrathoracic subclavian vein puncture under the guidance of both fluoroscopy and venography in the oblique beam projection. Pacemaker leads were implanted in ten patients under the guidance of both fluoroscopy and venography in the ipsilateral anterior oblique projection. The angle of projection was set as large as possible between 35 degrees and 45 degrees . The needle was held parallel to the X-ray angle of incidence and inserted toward the first rib, then withdrawn until the tip entered the subclavian vein. This modified method of pacemaker implantation was successful in all patients, with no complications during the follow-up period ranging from 4 to 19 months. It also prevented pneumothorax and lead entrapment in soft tissue associated with the clavicle that might be caused by the conventional technique.

Aged↗